Never disclose a patient’s transgender status to anyone who does not need to know this to provide medical care. Transgender identity should be treated like any other health disclosure and not fodder for office gossipIf possible, provide a patient with a private room during the duration of their stayVerifying all insurance related administration is adhered to strictly to ensure coverage of servicesEnsuring that medication regime is observed, particularly with time sensitive hormonesPartner with other medical and mental health care professionals to ensure that patients receive complete careSeek out training on transgender related health care issues-attend conferences, workshops, CEU trainings, articles, etc. (Mizzoni/Callen-Lourde)Taking HistoriesTaking Histories ContinuedNational Transgender Discrimination Survey78% of respondents report verbal harassment in K-12 schools, along with 35% physical and 12% sexual- leading 15% to drop out of school before graduationDouble the rate of unemployment, and 4x the rate for transgender people of color90% experience harassment, mistreatment or discrimination in the job setting and 47% reported adverse job outcome (being fired, not being hired or being denied a promotion)However, 80% experienced a more satisfying experience in the work environment post-transition, even with the harassment16% of respondents said un/under-employment led them to engage in an underground economy, such as selling drugs or sex work53% experienced harassment in a setting of public accommodation19% had Experienced Homelessness (and 55% who had accessed a shelter reported harassment by facility staff)30% had experienced police harassment and 48% shared that they would be uncomfortable asking for police assistance57% experienced significant family rejection85% higher rate of incarceration23% had experienced a catastrophic level of discrimination (considered 3 or more of the above)19% had been refused medical care because they were transgender (and up to 30% for trans people of color)50% had to teach their medical providers about transgender health issues and care 28% postponed care due to provider discrimination and 48% because of inability to afford services (lack of insurance coverage)41% of respondents had attempted suicideExtremely high rates of depression and anxiety, that lead to more complicated mental health concerns and self-harming behaviors71% tried to hide their gender identity or delayed their transition process to avoid discrimination, resulting in depression and anxiety4 times the national average for HIV and STIsDouble the national average for misuse of drugs/alcohol and smoking in an effort to cope with discrimination and harassment, causing a variety of physical, sexual and mental health issuesHigh rates of Injection Silicone Usage (ISU) and Street Hormones, which lead to a variety of health issues: infection, disfigurement, vulnerability to cancer, increased risk for heart disease and blood clots, etc.Avoidance of restrooms in public spaces, leading to urinary tract infections and permanent harm to the bladder/kidneyRefusal to admit or treat transgender patientsIntrusive and medically unnecessary examinations as a condition of treatmentRefusal to provide transgender patients services that they provide to other patientsHarassment or refusal to respond to harassment by staff or other patientsRefusal to provide counseling, medical advocacy or referrals, or other support servicesIsolation or deprivation of human contact, or limiting of participation in social or recreational activities offered to othersRequirement to participate in “conversion therapy” for the purpose of changing your gender identityHarassment, coercion, intimidation or interference of a trans-person’s ability to freely exercise your health care rightsKnow the difference between sex, gender and sexual orientationRefer to a patient by their real name and gender pronouns. If you aren’t sure what name/gender pronoun a person would like to be called, politely ask them. This is not considered intrusive and shows the patient that you respect them.Ensure that intake forms have “chosen name” and “sex" AND "gender” as options for patientsEnsure that any single-stall restrooms are labeled “Unisex” or “Gender Neutral” or "Universal"Establish an effective policy for addressing discriminatory comments or behaviorFocus on their care and resist the urge to ask questions that are motivated by your curiosity about transgender identityAvoid asking questions about surgical status and/or genitals unless it is germane to serving the patient’s health related issue